Systematic review and meta-analysis: surgical reparative treatment for orthopedic patients with ankle fracture complicated by peripheral tissue injury.

BACKGROUND: This study aimed to apply meta-analysis to study the efficacy of surgical repair treatment on ankle fractures. METHODS: The Boolean logic search method was adopted to retrieve relevant randomized control trials (RCTs), with "Fracture", "Ankles", "Fractured Foot", "Fractures Merge", and "Surgical Treatment" as search terms. The databases PubMed, Medline, HowNet, and others were searched from the time of their establishment. The software Review Manager (Rev Man 5.3) was used for meta-analysis. RESULTS: A total of 10 references were included in the study, and most of them had low-risk bias (medium-high quality). The results of meta-analysis showed that after surgical repair treatment, gait was good, while the gait score of the non-surgical group was poor. The result was Chi2 (Chi-squared Test) =57.91, df (degree of freedom) =5, I2=91%, P<0.1, mean difference (MD) =-9.21, 95% CI: -10.25 to -8.17, Z=17.36, P<0.05. The non-surgical group showed a higher degree of pain and poorer ankle and hindfoot functions vs. the surgical group. Also, the pain degree of the non-surgical repair combined with surrounding tissue group was higher, and the ankle and hindfoot functions were poorer vs. the surgical repair treatment group. The Pain intensity results of the surgical and non-surgical groups were Chi2 =12.89, df =2, I2=84%, P<0.1, MD =-9.51, 95% CI: -10.47 to -8.55, Z=19.39, P<0.05; the AOFAS scores of surgical repair treatment and non-surgical repair treatment were Chi2 =27.07, df =6, I2=78%, P<0.1, MD =8.89, 95% CI: 8.26 to 9.71, Z=24.30, P<0.05. It was revealed that surgical repair treatment can significantly reduce the postoperative pain of patients with ankle joint fractures, while the non-surgical repair treatment group had a higher degree of postoperative pain. The result was (MD =2.32, 95% CI: 2.16 to 2.48, I2=100%, Z=28.33, P<0.05). DISCUSSION: Surgical repair treatment of ankle fracture demonstrated significant curative effects, with fewer adverse reactions, and the stability of the ankle joint was well restored.

Effects of microsurgical repair treatment on the clinical efficacy, complications, and flap follow-up scores of patients with exposed steel plates after surgery for foot and ankle fractures.

BACKGROUND: Treatment of exposed steel plates after surgery for foot and ankle fractures is complicated. This study aims to analyze the effects of microsurgical repair treatment on the clinical efficacy, complications, and flap follow-up scores of patients with exposed steel plates following foot and ankle fracture surgery. METHODS: Eighty-two patients with exposure of steel plates after surgical treatment for foot and ankle fractures in our hospital from March 2017 to March 2018 were included in this study. The patients were divided into a study group (43 patients who received microsurgical repair) and a control group (39 patients who received conventional repair surgery). We compared the clinical efficacy, complication rate, flap followup score, recovery of ankle-hindfoot function and ankle function before treatment and at 3 and 6 months after treatment, and patient satisfaction between the two groups. RESULTS: The clinical effectiveness rate in the study group was 95.35%, which was higher than the control group (76.92%) (P<0.05). The flap appearance, texture, and elasticity scores in the study group were higher than those in the control group (P<0.05). After treatment, the American Orthopedic Foot and Ankle Society (AOFAS) score and Baird ankle score increased significantly in both groups, and reached a peak at 6 months after treatment. The peak scores of the study group were considerably higher than those of the control group at each period after treatment (P<0.05). The incidence of complications in the study group (6.98%) was lower than the control group (25.64%) (P<0.05). Patient satisfaction was higher in the study group (97.67%) than the control group (79.49%) (P<0.05). CONCLUSIONS: Microsurgical repair of exposed steel plates after surgery for foot and ankle fractures has a significant clinical effect. It can improve the flap follow-up scores, accelerate healing of the ankle, improve aesthetics, and reduce the incidence of complications. It is therefore worthy of widespread use in clinics.

[Minimally invasive percutaneous plate osteosynthesis technique for treatment of Neer II, III parts fracture of proximal humerus].

OBJECTIVE: To evaluate the clinical significance of minimally invasive percutaneous plate osteosynthesis (MIPPO) applied in Neer II, III parts fractures of proximal humerus. METHODS: The clinical data were retrospectively analyzed, from 30 patients with Neer II, III parts fractures of proximal humerus in accordance with selection criteria, who were treated with manual reduction and plaster external fixation (11 cases, non-operative group) or with MIPPO (19 cases, operative group) between January 2008 and May 2010. In non-operative group, there were 6 males and 5 females with an average age of 60 years (range, 56-80 years) and with an average time of 10 hours (range, 3-24 hours) between injury and reduction, including 8 cases of Neer II and 3 cases of Neer III. In operative group, there were 13 males and 6 females with an average age of 65 years (range, 45-78 years) and with an average time of 3 days (range, 1-5 days) between injury and operation, including 9 cases of Neer II and 10 cases of Neer III. There was no significant difference in gender, age, fracture type, and time from injury to operation (P > 0.05). The shoulder joint function before and after treatments was evaluated according to Constant-Murley Score (CMS) and American Shoulder and Elbow Surgeons' Form (ASES) scoring systems. RESULTS: Thirty patients were followed up. In operative group, the follow-up time ranged from 11 to 18 months (mean, 12 months); all incisions healed by first intention with no complication of internal fixation failure, infection, or nerve injury. In non-operative group, the follow-up time ranged from 9 to 15 months (mean, 11 months). The X-ray films showed that fractures healed without humeral head necrosis in 2 groups. The bone healing time in operative group and non-operative group was (11.47 +/- 2.48) weeks and (11.82 +/- 2.44) weeks, respectively, showing no significant difference (t = 0.369, P = 0.889). The CMS score and ASES score at each time point after treatment were significantly better than those before treatment (P < 0.05); the CMS scores in operative group were better than those in non-operative group at 3 weeks, 3 months, and 1 year after treatment (P < 0.05); and the ASES score in operative group was better than that in non-operative group at 3 weeks and 3 months after treatment (P < 0.05), but no significant difference was found at 1 year after treatment (P > 0.05). CONCLUSION: MIPPO fixation using the locking compression plate is an effective option for Neer II, III parts fractures of proximal humerus. It can provide good functional recovery of the shoulder joint so that patients can get back to their normal life as soon as possible.